Hosie, A., Agar, M., Lobb, E. A., Davidson, P. M., & Phillips, J. (2014). Identifying the barriers and enablers to pallative care nurses' recognition and assessment of delirium symptoms: A qualitative study. Journal of Pain and Symptom Management, Article in press.
Context: Delirium is under-recognised by nurses, including those working in palliative care settings where the syndrome occurs frequently. Identifying contextual factors that support and/or hinder palliative care nurses’ delirium recognition and assessment capabilities is crucial, to inform development of clinical practice and systems aimed at improving patients’ delirium outcomes.
Objective: To identify nurses’ perceptions of the barriers and enablers to recognising and assessing delirium symptoms in palliative care inpatient settings.
Methods: A series of semi-structured interviews, guided by critical incident technique, were conducted with nurses working in Australian palliative care inpatient settings. A hypoactive delirium vignette prompted participants’ recall of delirium and identification of the perceived factors (barriers and enablers) that impacted on their delirium recognition and assessment capabilities. Thematic content analysis was used to analyse the qualitative data.
Results: Thirty participants from 9 palliative care services provided insights into the barriers and enablers of delirium recognition and assessment in the inpatient setting, that were categorised as patient and family, health professional and system level factors. Analysis revealed five themes, each reflecting both identified barriers and current and/or potential enablers: i) value in listening to patients and engaging families; ii) assessment is integrated with care delivery; iii) respecting and integrating nurses’ observations; iv) addressing nurses’ delirium knowledge needs and v) integrating delirium recognition and assessment processes.
Conclusions: Supporting the development of palliative care nursing delirium recognition and assessment practice requires attending to a range of barriers and enablers at the patient and family, health professional and system levels.
palliative care, assessment, delirium